Evaluation of THE Doll project

1. Evaluation of THE Doll project In Greenland Karen Wistoft Professor (mso), Institute of Learning, University of Greenland Ilisimatusarfik & Associate Professor, Department of Education, AU, Campus Copenhagen

2. The Doll Project • Running since 2006 • More than 1400 students/youth had participated • Teaching carried out by local health workers or any other relevant professionals on site • The educators participate according to their interests and available resources

3. Objectives and goals Generel objective: All pregnancies in Greenland are wanted! Goals: • To reduce the number of teenage pregnancies • To reduce the cases of sexually transmitted diseases • To increase contraceptive awareness and use • To increase the average age of virginity loss • To encourage an active and realistic parental abmition amongst 13-18 year old boys and girls

4. Target groups Primary target groups: • Students in graduation grades in pubic school • 8th, 9th and 10th grade • Boarding school students Secondary target groups: • Students in high school or vocational training • Pregnant families with special needs Tertiary target groups: Parents of students/other family

5. Evaluation • Financed by Government of Greenland, Department of Infrastructure and Health • Scheduled for the period 1.3.2011-1.2.2013 • Evaluators: prof.(mso) Karen Wistoft & research assistant Mikkel Stovgaard, IUP/AU • In 2012 Naalakkersuisut decidedto carry out the doll project as a stationary health education program.

6. Premise • The doll behaves like a ‘real’ baby: it must be fed, changed, burped and comforted • Students get an insight into what is involved in caring for a baby • Increase awareness of the importance of planning if one wants a child • Increased motivation for parental and sex education

7. Doll Project Methods Day 1: • Interactive teaching 4-6 lessons • Distribution of dolls Day 2-3 • Childcare (bringing the dolls home) Day 4: • Reviewing the dolls • Continue dialogue-based teaching • Final remarks

8. Aims of the evaluation • To assess the Doll Project’s influence, qualities, potentials, challenges, and possible obstacles • To assess the students’ statements and discover if their attitudes have changed and they are more conscious about parental responsibilities – the importance as teenagers?

9. Evaluation Methods • Questionnaires before teaching/childcare (Greenlandic/Danish) • Parent questionnaires (mother/father) • Questionnaires after childcare • Observation of teaching (selected locations) • Telephone interviews with teachers • Supplemented by statistics by Chief Medical Office's reports and Greenland’s official Statistics Bank

10. Data • Questionnaire research (N=1068): • 802 questionnaires answered by students primarily in the age group 13-16 years • 266 questionnaires answered by parents of the participating students (45% fathers and 55% mothers) • Observations of the Doll Project’s teaching • Nuuk(4 X 3 days teaching) • Cities by the West coast (3 X 2 days teaching) • Chief Medical Office Reports • Births and abortions amongst teenagers by age and city • Sexually transmitted diseases amongst teenagers • Supplemented by statistics by Greenland’s official Statistics Bank (http://bank.stat.gl/)

11. Limits of the Evaluation • Students’ new thoughts and attitudes may be influenced by caring for the dolls and the education – but there may also be other explanations • Time perspective: doll care and teaching evaluation occurs immediately after completion – no follow up • There is no data to show if the students’ new thoughts are put into action (apart from doctors’ figures – in the longer term) • Changes in the number of teenage pregnancies/ abortions and sexually transmitted diseases may be due to other influences

12. Quality? • Do the teaching activities conform with the underlying concern (developed by the Danish Sex and Society)? • Are the project’s educational resources and teachers’ ability acceptable?  Are there qualified professionals available to carry out the work?

13. Alignment? • Do the teaching objectives, methods, and content match the students assumptions? • Is the targeted training properly designed for the students? • Are the teachers satisfied with the Doll Project’s methods/concepts, teaching materials and activities? • Are the teachers satisfied with student participation and learning outcomes? • Are the students satisfied with the education?

14. Main Evaulation Questions • Should teaching be based on dialogue between teachers and students or between students? • Does caring for the dolls create meaningful reflections with the students? • What affects students’ impressions most? From the above reflections, what does it mean to be a parent? • What specific exercises and activities do the teachers find most appropriate? • What learning outcomes do students acquire who participate in the education?

15. Main Questions (II) • Do students acquire knowledge about: youth rights, unacceptable violence, sexuality, habits and the need for contraception and safe sex? • Do they understand and are they able to use the knowledge about sex, sexually transmitted diseases and the use of contraception? • How is the teaching adapted to the students’ insights and everyday life? • How can the teaching be relevant and memorable? • How can it ensured that the teaching does not revert back to the traditional delivery of risks and moralising messages?

18. Care Time and Age • The effect is greatest for students who have cared for a doll rather than those who just attend the classes • 2-3 of care has significantly more impact than 0-1 days • The more that students cared for a doll, the more aware they became of the importance not to be alone with a child • The youngest students (13-14 years) are affected most by the Doll Project, e.g. changing opinions about what is involved in having a baby • The 17-19 year olds are affected the least

19. Students on the Doll Project Three Categories: • “informative and fun” • “important information” • “exhausting and hard”

20. Girls • Before the girls are generally more positive about families than boys, if they had a child “here and now” • Girls positive experiences of caring for children clearly seen – “my mother and grandparents would be happy” • After caring for dolls however, the girls stated it would be overall negative to have a child “here and now” • No girls thought that it would be positive any more…

21. Boys • Before had only a few boys thought about having a child and none wanted one “here and now” • After boys responded more positively but maybe “not right now”, their fatherly instinct has not kicked in • Many boys developed a more positive attitude about how it would be like, to be a parent

22. Significant for the Boys • There was a “transformation” with many of the boys • They show great tenderness • They are really serious • Scored in caring points • Several boys stated that they had “discovered their fatherly instinct” • Cannot be explained through the evaluation • Will require additional qualitative data (interviews/observations) Plus a longer study 

23. Selected results - reflections • The vast majority of students, have started to think differently about having a child after participating in the Doll Project • In comparison, 88% of students would like to have a child at some point in their life, which is greater than before the doll caring and teaching

24. Deterrence Awareness • Most students have not been scared off, in terms of becoming a parent • Students have specifically begun to reflect more carefully on the subject of parenthood • More students are aware that it would have negative consequences, including restrictions in terms of life and educational opportunities • The effect is generally not one of deterrence, but of awareness

25. Minor effect on values in families • Students respond differently, in terms of how they believe it would affect their family, if they had a child “here and now” • Approximately half of the students regard it as largelypositive for the family to have a baby "here and now“ • Students, particularly in coastal areas, believe that it would be extremely positive for the family, if they had a child "here and now". This is regardless of age (also applies to 13-14 year olds, boys and girls) and circumstances. • Even after their experience of doll care, there are still many students in these areas who believe that having a child in the family would have a positive impact • The doll care does not have an signifincant effect on the students’ positive assessment of what effect a child would have on the family, were they to have a child “here and now”

26. Parents’ questionnaire • It is significant that none of the parents, who participated in the evaluation questionnaire (N = 266), believe that it would be positive, if their son or daughter were to have a child now!

27. Prevention?

29. Impact on contraception motivation • A significant effect of both doll care and family and sex education is that students were significantly more motivated to use contraception than they were before • Almost no students, who prior to doll care had sex without using contraception, alleged that their habit would continue • Students' awareness of contraception has been intensified • Just how far this increased awareness of the importance of using contraception leads to altered behavior patterns has not been studied.

30. Percentage of students who have had sex not using contraception

31. Sex by Age

32. Sexually Transmitted Diseases

33. Significance: Nuuk - Coast • Age of becoming sexually active • Use of contraception • Teenage pregnancies • Previous desire for child • Significance for family • Effect of education • Teaching: approach, methods and concluding

34. Teaching Differences Reflective Health Education Behavioural Health Education Moralistic teaching Traditional blackboard teaching Passively factual informed teaching Scary images Patronising and Corrective Care score = Parental ability Objective: high parental percent and good baby report • Dialogue-based teaching • Active involvement • Progressive and didactic reflective teaching • Pictures of body changes • Appreciative and supportive • Care score  dialogues • Objective: to create new reflections and experiences

35. ‘Scary Images’

36. “Nice Job” (diploma lack of care and abuse)

37. Dialogue or not? • The scanning of the dolls is done in very different ways • Students can regard themselves as potentially good parents and therefore (soon) ready to have children… • Students, who achieve a very low pass rate, or if the doll has been subjected to "abuse“  negative impact on the student's self-image as a parent… • Students' self-esteem can be affected, if there is no discussion about the purpose of the doll care and limitations of what the results tell us about the student, including the fact that their pass percentage does not necessarily reflect the their ability or readiness to be a parent

38. Frustrating or fun? • A few students acted in the opposite intention of the Doll Project • “Unfortunately we discovered a doll which had burnt clothes in two places between the legs which would have penetrated the baby outfit. It looks as though a cigarette was used to burn it. We didn’t talk with the students about it when we first found it but after we had come home” (teacher)

39. Preliminary from the Chief Medical Office’s Reports • Fewer teenage pregnancies in Nuuk (2008-2011) where the Doll Project has been continuous running since 2006 • The youngest teenagers choose to abort more often than before • Similar trends in Sisimiut where the Doll Project also has been continuous running • This trend has not been observed in districts where the Doll Project has not been running  no larger trend amongst teenagers in Greenland • Large geographical differences in the prevalence of sexually transmitted diseases